The Management of Restless Legs Syndrome: An Updated Algorithm
Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised ...
The Mayo Algorithm is well known in this forum. If your GP is aware of the Mayo recommendations - which could be why they prescribed Gabapentin - they are comparatively unusual in UK medical circles. The majority still follow outdated NHS guidelines.
You say that Gabapentin stopped working for you? Have you followed the Mayo algorithm: "Gabapentin and pregabalin are usually administered as once- or twice-daily doses in the late afternoon or evening or before sleep. It is recommended to start treatment 1 to 2 hours before usual onset of symptoms. Treatment should commence at 300 mg of gabapentin (100 mg in patients older than 65 years) or 75 mg of pregabalin daily (50 mg in patients older than 65 years) and be increased every few days as needed. Most RLS patients require 1200 to 1800 mg of gabapentin daily, but doses up to 3600 mg daily can be used."
Have you also had a full panel iron test done and followed the Mayo algorithm: "it is recommended that all RLS patients with serum ferritin concentration of 75 μg/L (to convert to pmol/L, multiply by 2.247) or less and transferrin saturation below 45% should receive a trial of oral iron therapy......"
Yes, too much or too little exercise can be a factor as you've found. I don't know about salt, but both sugar and artificial sweeteners can be triggers. And yes, Magnesium helps some - but in my case it's not bathing in epsom salts or rubbing in oil that helps, but taking at least 400mg of Magnesium Citrate a day (although don't take this at the same time as an iron supplement, and be aware that oral Mg can cause diarrhoea in some people).
Follow posts by regulars such as Joolsg and Sue Johnson for further advice
If gabapentin stopped working, you were probably not taking enough or were taking it the wrong way. As ChrisColumbus mentioned According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." Ask your doctor for 100 mg capsules and increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. If you take magnesium, take it at least 3 hours before gabapentin as it interferes with the absorption.of gabapentin.
Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, dehydration, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, using a standing desk, listening to music and yoga.
Thank you so much for this. It's depressing to see that I'm down the list on the chronic refractory RLS. I have 150 oxydodones left, and then I must start the trips to doctors again to treat me after 150 days. It's hard to convince them that I will not respond to the long list of first line meds. Each new doctor wants to do that. Unfortunately, I have severe neck pain, so the oxy is doing double duty. I'm just so worried what's ahead for my future.
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My letter to all powers-that-be, following my desperation for urgent need for improvements in education of medics an in management of RLS
New take on RLS from a physical theapist point of view..
High levels of rare gut bacteria may be linked to restless legs syndromeby American Academy of Sleep Medicine
